This paper uses Multiple Indicator Cluster Surveys data from the Republic of Congo and São Tomé and Príncipe to study the relationships between child stature, mother's years of education, and indicators of early childhood development. The relationships are contrasted between two empirical approaches: the conventional approach whereby control variables are selected in an ad-hoc manner and the double machine-learning approach that employs data-driven methods to select controls from a much wider set of variables. Overall, the findings based on the preferable double machine-learning approach differ across the two countries depending on the measures of early childhood development and child stature (height-for-age Z-score and stunting) used in the analysis. Double machine-learning estimates for the Republic of Congo suggest that height-for-age Z-score and stunting have a direct causal effect on early childhood development. In contrast, for São Tomé and Príncipe, no relationship is found. Thus, country-specific policy advice based on the relationships observed from data in other countries may be quite risky, if not misleading. Double machine-learning provides a practical and feasible approach to reducing threats to internal validity to derive robust inferences based on observational data for evidence-based policy advice.
Even though several studies link access to infrastructure and wellbeing, very few clearly examine the impact of this relationship on children. so, does enhanced access to infrastructures improve child well-being? Thus, the study examines the contribution of access to infrastructure on children's well-being. It uses the Generalized Method of Moments (GMM) on 30 countries in sub-Saharan Africa from 2000 to 2020.. Results of the study show that access to education, healthcare, electricity and sanitation helps reduce child mortality and anemia. Thus, authorities in developing countries should Improve the construction and development of these infrastructures. Furthermore, public policies should ensure that infrastructures are accessible to all children, including those with special needs or living in rural or disadvantaged areas.
This paper assessed the effect of maternal labour force participation on child well-being in Cameroon using data extracted from the 2018 Cameroon Demographic and Health Survey. The Instrumental Two- Stage- Least Squares (IV2SLS) technique, controlling for endogeneity was employed to analyse the effect of maternal labour force participation on child well-being in Cameroon. The results of the Instrumental Two- Stage- Least Squares (IV2SLS) revealed that maternal labour force participation had a positive and statistically significant effect on child well-being in Cameroon. Decomposing maternal labour force participation effect on child well-being, we realised that it was more of an issue of secondary education due to inadequate education and training. Based on the results, the paper recommends that development policies should continue to adhere to international conventions which promote the education of women and their emancipation so as to enhance their participation in the labour force in a bid to enhance child well-being.
Ndah Justus Nkezi, Dobdinga Cletus Fonchamnyo, Ibrahim Nji Ngouhouo
Background Child stunting remains a major public health challenge in the Democratic Republic of the Congo (DRC), reflecting persistent inequalities in child nutrition and health outcomes. This study examines the distribution and spatial variation of height-for-age z-scores (HAZ) among children under five, while also assessing the influence of selected demographic and socioeconomic factors. Methods Data were obtained from the 2023–2024 Demographic and Health Survey (DHS-8). A structured additive regression model was then applied to assess the effects of child age and maternal education, allowing for nonlinear relationships through smooth functions. To capture geographic heterogeneity, spatial effects were decomposed into structured (spatially correlated) and unstructured (area-specific random) components, enabling the identification of regional clustering and residual province-level variation in stunting. Results Geographic analysis reveals substantial regional disparities in stunting prevalence across the 26 provinces of the DRC. The province of Kwilu emerges as a major hotspot with very high levels of stunting, while several provinces fall within medium to high prevalence categories, indicating that stunting is a widespread issue across the country. Model results highlight important nonlinear relationships for certain predictors. Child’s age shows a strong negative trend with stunting risk: younger children have higher log-odds of stunting, and the risk decreases sharply with age. Maternal education displays a weaker and nonlinear association, with generally small effects across most education levels and greater uncertainty at higher levels of schooling. Spatial modeling further demonstrates that geographic factors significantly contribute to variation in stunting outcomes. Both structured spatial effects, indicating regional clustering, and unstructured spatial effects, reflecting province-specific deviations, contribute to the observed patterns. The combined spatial effect suggests persistent geographic disparities even after adjusting for covariates, although uncertainty varies across regions. Conclusions The findings underscore the importance of geographic context and early childhood factors in shaping stunting outcomes in the DRC, highlighting the need for targeted, context-specific interventions to address persistent nutritional inequalities.
This study examined the impact of portfolio assessment on evaluating the English language skills of pupils with hearing impairment in Fako Division, Cameroon. Portfolio assessment, as an informal and learner-centred approach, was explored within the framework of inclusive education, where traditional assessment methods often fail to adequately reflect the abilities of learners with hearing loss. The research utilised a quasi-experimental design involving pupils with hearing impairment in selected inclusive primary schools. Data were gathered through English language tests, classroom observations, and interviews with parents, teachers, head teachers, and the divisional delegate. Quantitative data were analysed using descriptive statistics, t-tests, and regression analysis, while qualitative data underwent thematic analysis. The results indicated that pupils subjected to portfolio assessment performed significantly better in English language skills than those assessed through conventional methods. Statistical analysis (SPSS t-tests and regression) showed that pupils assessed via portfolios scored notably higher on post-tests (portfolio group mean=12.78 versus control=11.14; t(38)=2.919, p<.05). Regression analysis demonstrated that portfolio use was a strong predictor of language improvement (β=0.336, p<.001). Classroom observations and interview findings further revealed that portfolio assessment encouraged ongoing learning, increased learner engagement, self-reflection, and heightened teacher awareness of individual progress. The study concludes that portfolio assessment is an effective method for evaluating the English language skills of pupils with hearing impairment and recommends its systematic adoption within inclusive classroom practice.
ABSTRACTIntroduction. Human papillomavirus (HPV) vaccination is the primary strategy for preventing cervical cancer. However, vaccination coverage remains low in Cameroon. This study aimed to identify women's perceived barriers to HPV vaccination among girls aged 9–14 years and to propose strategies to improve vaccine uptake in the Dschang and Foumbot health districts. Methods. A quantitative cross-sectional study was conducted from August 2025 to January 2026 among 110 mothers or guardians of girls aged 9–14 years. Data were collected through face-to-face interviews using a pretested semi-structured questionnaire and analyzed with RStudio using descriptive statistics and Pearson’s chi-square test, with statistical significance set at p < 0.05. Results. Overall, 60% of participants reported that their daughters had not received the HPV vaccine. The main barriers identified were lack of information (21.8%), concerns about vaccine safety (30.9%), cultural or religious beliefs, distance to vaccination centers (36.4%), and vaccine unavailability (34.6%). Healthcare provider recommendations were the main factor influencing vaccination decisions (40%). School-based vaccination programs (56.4%) and strengthened awareness campaigns (65.5%) were the most frequently proposed strategies to improve vaccine uptake. Higher levels of information, discussions with healthcare providers, and better access to vaccination services were significantly associated with HPV vaccination (p < 0.05). Conclusion. HPV vaccination coverage remains suboptimal in West Cameroon. Strengthening public awareness, increasing healthcare provider involvement, implementing school-based vaccination programs, and improving vaccine availability could enhance vaccine uptake and contribute to cervical cancer prevention.RÉSUMÉ Introduction. La vaccination contre le virus du papillome humain (HPV) constitue la principale stratégie de prévention du cancer du col de l'utérus. Cependant, la couverture vaccinale demeure faible au Cameroun. Cette étude visait à identifier les obstacles perçus par les femmes à la vaccination contre le HPV chez les jeunes filles âgées de 9 à 14 ans et à proposer des stratégies pour améliorer l'adhésion vaccinale dans les districts de santé de Dschang et de Foumbot. Méthodes. Une étude transversale quantitative a été menée d'août 2025 à janvier 2026 auprès de 110 mères ou tutrices de jeunes filles âgées de 9 à 14 ans. Les données ont été recueillies par entretiens individuels à l'aide d'un questionnaire semi-structuré prétesté, puis analysées sous RStudio au moyen de statistiques descriptives et du test du chi-deux de Pearson, avec un seuil de signification statistique fixé à p < 0,05. Résultats. Dans l'ensemble, 60 % des participantes ont déclaré que leurs filles n'avaient pas reçu le vaccin contre le HPV. Les principaux obstacles identifiés étaient le manque d'information (21,8 %), les craintes concernant la sécurité du vaccin (30,9 %), les croyances culturelles ou religieuses, la distance jusqu'aux centres de vaccination (36,4 %) et l'indisponibilité du vaccin (34,6 %). La recommandation par un personnel de santé constituait le facteur majeur influençant la décision de vaccination (40 %). Les programmes de vaccination en milieu scolaire (56,4 %) et le renforcement des campagnes de sensibilisation (65,5 %) étaient les stratégies les plus fréquemment proposées pour améliorer la couverture vaccinale. Un niveau d'information plus élevé, les échanges avec les professionnels de santé et un meilleur accès aux services de vaccination étaient significativement associés à la vaccination contre le HPV (p < 0,05). Conclusion. La couverture vaccinale contre le HPV reste suboptimale dans l'Ouest-Cameroun. Le renforcement de la sensibilisation du public, une plus grande implication du personnel de santé, la mise en œuvre de programmes de vaccination en milieu scolaire et l'amélioration de la disponibilité des vaccins pourraient accroître l'adhésion vaccinale et contribuer à la prévention du cancer du col de l'utérus.
ABSTRACTIntroduction. Malaria vaccination is an important additional strategy for preventing childhood malaria, but successful implementation depends on caregiver confidence and reliable service delivery. Evidence from conflict-affected settings in Cameroon remains limited. This study explored perspectives on malaria vaccine acceptance, hesitancy and implementation challenges in the North-West Region of Cameroon. Materials and Methods. A qualitative component was nested concurrently within a mixed-methods study in selected communities and health facilities in Bamenda and Bamenda III Health Districts. In-depth interviews were conducted with 18 mothers of children under five years, and key-informant interviews involved 26 healthcare workers and malaria vaccine programme implementers. Data were analysed thematically through familiarisation, coding, development and review of themes, and interpretation in relation to the study objectives. Results. Mothers described concerns about vaccine safety and effectiveness, fear of future vaccine resistance, limited vaccine availability, inadequate knowledge, and negative reports from early recipients. Implementers described caregiver hesitancy, poor community awareness, insecurity and difficult access to communities, vaccine shortages and supply delays, inadequate training and staffing, and cultural and religious beliefs. The findings showed a persistent gap between willingness to vaccinate and the practical availability and accessibility of vaccination services. Conclusion. Malaria vaccine acceptance may be undermined by both demand-side concerns and supply-side constraints. RÉSUMÉIntroduction. La vaccination contre le paludisme constitue une stratégie complémentaire importante pour prévenir le paludisme chez l’enfant, mais le succès de sa mise en œuvre dépend de la confiance des personnes qui s’occupent des enfants et de la fiabilité des services fournis. Les données issues de zones touchées par des conflits au Cameroun restent limitées. Cette étude a exploré les points de vue sur l’acceptation du vaccin contre le paludisme, les réticences à l’égard de celui-ci et les défis liés à sa mise en œuvre dans la région du Nord-Ouest du Cameroun. Matériel et méthodes. Un volet qualitatif a été intégré simultanément à une étude utilisant des méthodes mixtes, menée dans des communautés et des établissements de santé sélectionnés des districts sanitaires de Bamenda et de Bamenda III. Des entretiens approfondis ont été menés auprès de 18 mères d’enfants de moins de cinq ans, et des entretiens avec des informateurs clés ont été réalisés auprès de 26 professionnels de santé et responsables de la mise en œuvre du programme de vaccination contre le paludisme. Les données ont été analysées de manière thématique à travers les étapes suivantes : familiarisation, codage, élaboration et révision des thèmes, puis interprétation au regard des objectifs de l’étude. Résultats. Les mères ont fait part de leurs inquiétudes concernant la sécurité et l’efficacité du vaccin, de leur crainte d’une future résistance au vaccin, de la disponibilité limitée du vaccin, d’un manque de connaissances et de témoignages négatifs émanant des premiers bénéficiaires. Les responsables de la mise en œuvre ont évoqué les hésitations des aidants, la faible sensibilisation de la communauté, l’insécurité et la difficulté d’accès aux communautés, les pénuries de vaccins et les retards d’approvisionnement, l’insuffisance de la formation et des effectifs, ainsi que les croyances culturelles et religieuses. Les résultats ont mis en évidence un écart persistant entre la volonté de vacciner et la disponibilité et l’accessibilité concrètes des services de vaccination. Conclusion. L’acceptation du vaccin contre le paludisme peut être compromise tant par des préoccupations du côté de la demande que par des contraintes du côté de l’offre.
BACKGROUND: Cameroon introduced the RTS, S/AS01 malaria vaccine into routine expanded immunisation (EPI) in 2024, targeting 42 priority health districts. We assessed changes in total malaria burden between intervention and non-intervention districts over 2023-2025. METHODS: We conducted a retrospective, quasi-experimental, ecological longitudinal study using a difference-in-differences (DiD) approach on routine district-level surveillance data from 206 districts (42 intervention, 164 non-intervention) for 2023-2025. Outcomes included severe malaria rate (per 1,000 children < 5), uncomplicated malaria rate, all malaria-related hospitalisations, and malaria mortality rate (per 100,000). Crude pre-post changes and DiD were calculated. Adjusted linear DiD models with district and year fixed effects and cluster-robust standard errors were also fitted. Subgroup analyses examined interactions with seasonal malaria chemoprevention (SMC), intermittent preventive treatment in infants (IPTi), insecticide-treated nets (ITNs), and ecological region. RESULTS: Baseline characteristics differed significantly: intervention districts had higher ITN coverage (60.2% vs. 45.5%, p = 0.006), higher IPT coverage (35.1% vs. 24.4%, p = 0.001), and larger populations (median 121,284 vs. 89,592, p = 0.029). From 2023 to 2025, intervention districts experienced larger declines in all outcomes. Crude DiD showed a 2.6 per 1000 (15%) reduction in severe malaria, 8.1 per 1000 (22%) reduction in uncomplicated malaria, 5.3 per 1000 (28%) reduction in hospitalisations, and 4.1 per 100,000 (26%) reduction in malaria deaths. Adjusted linear DiD estimates were not statistically significant (e.g., severe malaria coefficient - 0.54, 95% CI - 11.07 to 9.99, p = 0.920). Subgroup analyses indicated the largest effects in the Sahel (crude rate ratio 0.78) and added benefit when the vaccine was combined with SMC (additional - 5.6 per 1000 reduction). In 2025 alone, vaccination averted an estimated 7,200 severe cases, 12,800 uncomplicated cases, 5,300 hospitalisations, and 77 deaths. CONCLUSION: Crude trends show favourable declines in malaria burden in intervention districts, but adjusted estimates were null, likely due to selection bias and low power. These findings support continued vaccine scale-up and use of routine data for monitoring, while acknowledging the limitations of non-randomised evaluations.
Cavin Epie Bekolo, Nina Ngouenko, Esther Laura Nyame Dipepa Nwall et al.
Background Neonatal pain remains inconsistently assessed, particularly in resource-limited settings. We assessed healthcare professionals’ knowledge and reported practices regarding postoperative neonatal pain assessment in Kinshasa, Democratic Republic of the Congo (DRC). Methods We conducted a multicenter cross-sectional survey from August 2025 to May 2026 in ten hospitals with pediatric surgical activity. Healthcare professionals completed a 20-item questionnaire developed through expert content review and pretesting. The primary outcome was self-reported use of a standardized neonatal pain-assessment tool. A four-item knowledge score (0–4) was constructed, with ≥3 indicating high knowledge as a pragmatic study-specific threshold. Multivariable logistic regression used hospital-level cluster-robust standard errors. Results Of 580 healthcare professionals approached, 536 returned the questionnaire; six were excluded because of >30% missing data, leaving 530 complete questionnaires for analysis. Although 86.8% recognized neonatal pain, only 10.0% reported using a standardized pain-assessment tool, and 15.3% reported postoperative pain assessment at regular intervals. Nearly all participants (99.8%) reported no dedicated neonatal pain training. The mean knowledge score was 2.16 ± 0.84, and 34.7% had high knowledge. Higher knowledge was independently associated with reported standardized tool use (adjusted OR 4.90, 95% CI 3.10–7.70; p < 0.001). In the prespecified sensitivity analysis using the reduced three-item knowledge score, the association remained significant but was attenuated (adjusted OR 1.93, 95% CI 1.23–3.03; p = 0.004). Conclusion Reported use of standardized neonatal pain-assessment tools and regular postoperative pain assessment were low despite widespread recognition of neonatal pain. Higher knowledge was associated with reported tool use, although the association was attenuated after excluding scale recognition from the knowledge score. These findings highlight gaps in neonatal pain assessment and training, while the cross-sectional design precludes causal interpretation.
Eriksson Landu, Joseph Nsiala, Arriel Makembi Bunkete et al.
